Healthcare Provider Details

I. General information

NPI: 1871178012
Provider Name (Legal Business Name): KENNETH MARK SUDOL PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. KENNETH MARK SUDOL

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR UNIT MEDDAC
COLORADO SPRINGS CO
80913-4604
US

IV. Provider business mailing address

1650 COCHRANE CIR UNIT MEDDAC
COLORADO SPRINGS CO
80913-4604
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-4400
  • Fax:
Mailing address:
  • Phone: 719-524-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP035497L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: